Decubitus (pressure) ulcer, Stage IV (involves muscle, tendon, or bone)

ICD10 Diagnosis
Dx:	Decubitus (pressure) ulcer, Stage IV (involves muscle, tendon, or bone)
ICD10 code:	L89.3
Pre-ICD10 counterpart:	Ulcers - Decubitus only
Charlson/ALERT Scale:	none
APACHE Como Component:	none
APACHE Acute Component:	none
Start Date:
Stop Date:
External ICD10 Documentation	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

This diagnosis is a part of ICD10 collection.

• SMW
  • 2019-01-01
  • 2999-12-31
  • L89.3

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Additional Info

Pressure Ulcer on Wikipedia

• Stage 4 - Full thickness tissue loss- slough and eschar may be present on some parts of wound bed.
• Involves dermis, epidermis, subcutaneous and deep tissue such as bone or tendon

Coding multiple ulcers

• If there are pressure ulcers on DIFFERENT body parts (e.g. left heel, right heel, coccyx) then code them separately -- even though they will not be readily distinguishable as the code doesn't include body location.

• If there are multiple pressure ulcers close to each other on the same body part (e.g. coccyx area) then only code the one of the highest/worst stage.

Coding Progression of Ulcers

• Progression of Ulcers should be coded following our guidelines for Acquired Diagnosis combine each stage progression with the date and time it was noted in the chart.

If there are multiple pressure ulcers follow the above guidelines -- even though they will not be readily distinguishable as the code doesn't include body location.

• Julie will report on the worst stage from Acquired Diagnosis

• NOTE: As per our TASK meeting , there was a significant rise in the number of acquired stage 1 and 2 decubitus ulcers at the GGH ICU, beginning Jan 2022.

A sample of charts from the timeframe of concern was audited, and we collaborated with the GGH educator and manager and we were unable to determine a reason for this rise. Going forward, a recommendation will be forwarded to the OIT committee, and education about proper documentation of stages of decubitus ulcers will be reinforced across all sites. This will begin in March 2024. Up until March 2024 the data re. acquired decubitus ulcers is not reliable, as it often required the collector to subjectively interpret documentation on the stage of the decubitus ulcer.

Alternate ICD10s to consider coding instead or in addition

Decubitus ulcer codes:

Decubitus (pressure) ulcer, Stage I (surface reddening) Decubitus (pressure) ulcer, Stage II (to fascia, just under skin) Decubitus (pressure) ulcer, Stage III (deep, to but not including muscle) Decubitus (pressure) ulcer, stage not indicated

Or:

• Ulcers - Diabetic foot only
• Skin ulcer, NOS

Candidate Combined ICD10 codes

Related CCI Codes

• code Debridement if applicable
• code Amputation if applicable

Data Integrity Checks (automatic list)

none found

Related Articles

Skin	Trauma Abdominal trauma Burn Chemical burn Fracture Head trauma Head trauma (old) Joint/ligament trauma Lower limb trauma Muscles/tendon trauma Neck trauma Potential trauma Thoracic trauma Traumatic Amputation Traumatic fracture Upper limb trauma Vascular trauma	Renal/urinary Chronic kidney disease Nephritic syndrome Renal failure Renal/Urinary neoplasm Urinary tract infection	Infectious disease Antibiotic resistance Bacteria COVID Double duty pathogen Encephalitis Fungus Iatrogenic infection Infection requiring pathogen Infection with implied pathogen Influenza Intra-abdominal infection Lower respiratory tract infection Meningitis Non-specific pathogens Osteomyelitis Pathogens Pneumonia Potential infection Tuberculosis Upper respiratory tract infection Virus
ENT	Testing Imaging	Cardiovascular Aneurysm Aortic Aneurysm Arrhythmia Arterial thromboembolism Atherosclerosis Cardiac septum problem Cerebral Hemorrhage/Stroke Heart valve disease Hemorrhage Hypertension Hypotension Ischemia Ischemic gut Ischemic heart disease Myocardial Infarction Pulmonary embolism Pulmonary hypertension Vasculitis Venous thromboembolism	Hereditary/congenital
Eye	Mechanism Transportation mechanism	Neoplastic Benign neoplasm Endocrine neoplasm Female genital neoplasm Gastrointestinal neoplasm Heme/immunology neoplasm Leukemia Lymphoma Male genital neoplasm Metastasis Musculoskeletal/soft tissue neoplasm Neuro neoplasm Primary malignancy Renal/Urinary neoplasm Respiratory neoplasm Skin neoplasm	Heme/immunology Allergy Anemia Heme/immunology neoplasm Hemophilia Leukemia Thrombocytopenia
Misc Adverse effect Alcohol related Allergy Anesthetic related Antidepressant related Awaiting/delayed transfer COVID Cannabis related Cocaine related Decubitus ulcer Diagnosis implying death Electrolyte disturbance Exposure Fistula Hallucinogen related Has one Healthcare contact Hemorrhage Iatrogenic Metabolic/nutrition Non-traumatic fracture Observation Organ removal Ostomy Overdose Paralysis Past medical history Poisoning Psychoactive substance NOS related Radiation related Retired Code Rheumatic disease Sedative related Shock Solvent related Spine Stimulant related Transplant	Reproductive Abortion Breast disease Female genital neoplasm Male genital neoplasm Peripartum	Gastrointestinal Cirrhosis GI ulcer Gastroenteritis Gastrointestinal neoplasm Hepatitis Hernia Inflammatory Bowel Disease Intra-abdominal infection Ischemic gut Liver disease Liver failure Pancreas disease Pancreatitis Peptic ulcer	Musculoskeletal/soft tissue Hernia Joint/ligament trauma Muscle problem Muscles/tendon trauma Musculoskeletal/soft tissue neoplasm Osteomyelitis
Psych Addiction Antidepressant related Delirium Dementia Hallucinogen related Opioid related Psychoactive substance NOS related Sedative related Solvent related Stimulant related Withdrawal	Respiratory Asthma Influenza Inhalation Lower respiratory tract infection Pleural abnormalities Pneumoconiosis Pneumonia Pneumothorax Pulmonary embolism Respiratory neoplasm Sleep disorder Tracheostomy Upper respiratory tract infection	Poisoning Acute intoxication Addiction Opioid related Overdose Poisoning by non-pharmaceuticals Stimulant related Withdrawal
Neuro Cerebral Hemorrhage/Stroke Encephalitis Encephalopathy Meningitis Neuro neoplasm Paralysis	Symptom/Sign Pain	Endocrine disorder Adrenal Insufficiency Diabetes Endocrine neoplasm Metabolic/nutrition

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ICD10 Categories: ANCA-associated Vasculitis (AAV), Abdominal trauma, Abortion, Acute intoxication, Addiction, Adrenal Insufficiency, Adverse effect, Alcohol related, Allergy, Anemia, Anesthetic related, Aneurysm, Antibiotic resistance, Antidepressant related, Aortic Aneurysm, Arrhythmia, Arterial thromboembolism, Asthma, Atherosclerosis, Awaiting/delayed transfer, Bacteria, Benign neoplasm, Breast disease, Burn, COVID, Cannabis related, Cardiac septum problem, Cardiovascular, Cerebral Hemorrhage/Stroke, Chemical burn, Chronic kidney disease, Cirrhosis, Cocaine related, Decubitus ulcer, Delirium, Dementia, Diabetes, Diagnosis implying death, Double duty pathogen, ENT, Electrolyte disturbance, Encephalitis, Encephalopathy, Endocrine disorder, Endocrine neoplasm, Exposure, Eye, Female genital neoplasm, Fistula, Fracture, Fungus, GI ulcer, Gastroenteritis, Gastrointestinal, Gastrointestinal neoplasm, Hallucinogen related, Has one, Head trauma, Head trauma (old), Healthcare contact, Heart valve disease, Heme/immunology, Heme/immunology neoplasm, Hemophilia, Hemorrhage, Hepatitis, Hereditary/congenital, Hernia, Hypertension, Hypotension, Iatrogenic, Iatrogenic infection, Iatrogenic mechanism, Imaging, Infection requiring pathogen, Infection with implied pathogen, Infectious disease, Inflammatory Bowel Disease, Influenza, Inhalation, Intra-abdominal infection, Ischemia, Ischemic gut, Ischemic heart disease, Joint/ligament trauma, Leukemia, Liver disease, Liver failure, Lower limb trauma, Lower respiratory tract infection, Lymphoma, Male genital neoplasm, Mechanism, Meningitis, Metabolic/nutrition, Metastasis, Misc, Muscle problem, Muscles/tendon trauma, Musculoskeletal/soft tissue... further results